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Master Thesis

Comparaison des techniques de fermeture cutanée des dispositifs cardiaques rythmiques implantables : colle biologique versus fil non résorbable

Abstract : Background: multiple options are available for closure of incisions after implantation of cardiac electronic device. The aim of our study was to compare postoperative outcomes between conventional simple interrupted nylon sutures and sutures with a topical skin adhesive, the 2-octyl cyanoacrylate after implantation of cardiac electronic device and to study the medico-economic aspect. Materials and Methods: we retrospectively reviewed the records of all of patients who underwent implantation of a pacemaker (PM) and a cardioverter defibrillator (ICD) between January 2016 and December 2017 with a follow-up of minimum one year. Development of wound complications and cost of each technique were compared. Results: 745 patients were included, 321 in the skin adhesive group (215 PM, 103 ICD, 3 subcutaneous implantable cardioverter defibrillators (S-ICD)) and 424 in the suture group (200 PM, 216 ICD, 8 S-ICD). There were no significant differences between the two groups regarding haematomas (11 that is 3,4% in the skin adhesive group vs. 27 that is 6,4% in the suture group, p=0,0708) and infectious complications (3 that is 0,9% in the skin adhesive vs. 4 that is 0,9% in the suture group, p=1). There was a significant decrease in the number of pocket hematomas in patients implanted with a skin adhesive-closure pacemaker (2.3% vs. 7% in the thread group, p=0.0228), with no significant difference in term of anticoagulant treatment in the thread group (23% vs. 16,3% in the skin adhesive group, p=0.0843). There was also a strong tendency for the number of hematomas to decrease in patients implanted with a pacemaker with an anticoagulant (AVK or AOD) in the skin adhesive group (0% vs. 16,1% in the thread group, p=0.0586). The initial cost of the skin adhesive is higher but the cost away from the hospital is not negligible in the suture group. The global cost of medical care is significantly less in the skin adhesive group. Conclusion: the use of 2-octyl cyanoacrylate topical skin adhesive for wound closure following implantation of electronic cardiac device seems to be safe and cheaper for the community, associated with a significant decrease in pocket hematoma in patients implanted with a pacemaker. This method is an alternative effective option for wound closure in cardiac rhythm device.
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https://dumas.ccsd.cnrs.fr/dumas-02420372
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Submitted on : Thursday, December 19, 2019 - 6:34:26 PM
Last modification on : Saturday, January 18, 2020 - 1:30:21 AM
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  • HAL Id : dumas-02420372, version 1

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Sarah Dufont. Comparaison des techniques de fermeture cutanée des dispositifs cardiaques rythmiques implantables : colle biologique versus fil non résorbable. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02420372⟩

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